last MS of nursing care

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Osteomyelitis

osteomyelitis is an infection in the bone or bone marrow. infections can reach a bone by traveling thru the bloodstream or spreading from nearby tissue. osteomyelitis can also begin in the bone itself if an injury exposes the bone to germs

infection in the bone

difficult to treat

can become chronic

Risk factors of osteomyelitis

recent injury/trauma/orthopedic

- severe bone fracture, surgery, deep animal bites

circulation disorders

- poorly controlled, perpheral arterial dx

Problems requring IV lines/catheters (JACHO trying to correct)

- central lines, dialysis machine, IVD abuse

Condition of immune system

- long term high dose steriods or immunosuppressive therapy, chemo, organ translant

Causative Organisms

organisms

S. aureus, streptococci, e. coli, pseudomonas, virus, fungus

CLassification

hematogenous spread

contigous spread

vascular insufficiency-ischemia

Path of Osteomyelitis

infection followed by inflammatory effects

Thrombosis occurs can lead to ischemia with bone necrosis- bc the blood is not able to get in

abscess formation with dead bone tissue may occur (sequestrum)

new bone growth (involcucrum) around the dead bone tissue- if treatment is not strong enough

can lead to chronic osteomyelitis

Priority of care is infection control

Signs and symptoms osteomyel

Acute: onset sudden

manifestation of sepsis (origin in blood)

bone becomes painful, swollen, tender

pain incr with movement

Chronic

- non healing ulcer, may be a sinus with drainage

take care of infection order for antibiotic

skin integrity

tough infection to treat bc u dont things will get worst

Diagnostics osteomyel

Physical exam

elevated WBC (5-11), ESR cbc w/diff

wound and blood cultures- pathogen

x-ray- how far has it effected the bone

bone scans

bone biopsy- to make sure no cancer

MRI

hard to treat

Management of osteomyelitis

early identification and treatment- goes fast

IV antibiotics, pain management, diet (high protein to help with blding of tissue and cells)

Immobilization

surgical debridement- taking dead tissue out

closed wound drainage system

home care/referrals/PT

teaching/prevention- pathologic fracture

emotional support

Complication of osteomyelitis

bone death- osteonecrosis

impaired growth

skin cancer- low %

pathological fracture

septic arthritis

General complication of fracture septic arthritis

invasion of joint cavity with microbes (large bones, in between spaces)

8. assess labs (CBC. ABG, BUN. Cr)- PaO2- 80-10, <60- tells u how much perfusion the cells and tissues are getting. less than 60 damage. BUN- 7-18, cre 0.6-1.2 (how much kidneys have to do its function